DOCSLIB.ORG

Clinical Manifestation and Survival of Patients with I Diopathic Bilateral

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Manifestation and Survival of Patients with I Diopathic Bilateral ORIGINAL ARTICLE Clinical Manifestation and Survival of Patients with Mizuhiro Arima, TatsujiI diopathicKanoh, Shinya BilateralOkazaki, YoshitakaAtrialIwama,DilatationAkira Yamasaki and Sigeru Matsuda Westudied the histories of eight patients who lacked clear evidence of cardiac abnormalities other than marked bilateral atrial dilatation and atrial fibrillation, which have rarely been dis- cussed in the literature. From the time of their first visit to our hospital, the patients' chest radio- graphs and electrocardiograms showed markedly enlarged cardiac silhouettes and atrial fibrilla- tion, respectively. Each patient's echocardiogram showed a marked bilateral atrial dilatation with almost normal wall motion of both ventricles. In one patient, inflammatory change was demonstrated by cardiac catheterization and endomyocardial biopsy from the right ventricle. Seven of our eight cases were elderly women.Over a long period after the diagnosis of cardiome- galy or arrhythmia, diuretics or digitalis offered good results in the treatment of edema and congestion in these patients. In view of the clinical courses included in the present study, we conclude that this disorder has a good prognosis. (Internal Medicine 38: 112-118, 1999) Key words: cardiomegaly, atrial fibrillation, elder women,good prognosis Introduction echocardiography. The severity of mitral and tricuspid regur- gitation was globally assessed by dividing into three equal parts Idiopathic enlargement of the right atrium was discussed by the distance from the valve orifice. The regurgitant jet was de- Bailey in 1955(1). This disorder may be an unusual congenital tected on color Doppler recording in the four-chamber view malformation. A review of the international literature disclosed and classified into one of the three regions (-: none, +: mild, that although several cases have been discussed since Bailey's ++:moderate, +++: severe). Definite pulmonary hypertension report (2-17), idiopathic bilateral atrial dilatation is not well was defined as more than 25 mmHg, which was calculated by known (18-20). We discuss eight patients with bilateral atrial Doppler echocardiography (-: none, +: mild). Patients with le- dilatation who presented with no other cardiac abnormalities sions known to be secondary to atrial enlargement were ex- exceptfor atrial fibrillation. cluded. We investigated the clinical features and treatment course of each patient. Results of chest radiographs, electro- Methods cardiograms, and two-dimensional and color Doppler echocardiograms, when available, were examined. Four patients We studied the histories of eight patients, one man and seven had undergone magnetic resonance imaging. Wewerenot able women, treated for bilateral atrial dilatation within the past 13 to perform all of the tests on the more elderly patients. years at our hospital. The cardiothoracic ratio exceeded 65% Transesophageal echocardiography had been performed on in the patients studied. We used two-dimensional and color three patients. Cardiac catheterization and endomyocardial bi- Doppler echocardiographic findings to determine the follow- opsy from the right ventricle were performed on one patient. ing: 1) a left atrial short dimension of more than 55mm in the left parasternal window; 2) a right atrial short dimension of more than 55mm in the four-chamber view; 3) no disturbance Results in left ventricular wall motion and no structural abnormalities atient characteristics and clinical features (Table 1) of the tricuspid, mitral, aortic, and pulmonary valve complexes; The patient group consisted of one manand seven women 4) no severe mitral regurgitation and/or aortic regurgitation, with a mean age of 70 years (range, 47 to 87 years). Dyspnea and no abnormal shunt flow confirmed by color Doppler wasP the chief complaint of four patients, and generalized edema From the Division of Cardiology, Department of Internal Medicine, Juntendo Urayasu Hospital, Juntendo University School of Medicine, Chiba Received for publication February 25, 1998; Accepted for publication November 9, 1998 eprint requests should be addressed to Dr. Mizuhiro Arima, the Division of Cardiology, Department of Internal Medicine, Juntendo Urayasu Hospital, R Juntendo University School of Medicine, 2-1-1 Tomioka, Urayasu, Chiba 279-0021 112 InternalMedicineVol. 38, No. 2 (February 1999) Idiopathic Bilateral Atrial Dilatation Table 1. Patient Characteristics and Clinical Features C a s e N o . S e x A g e (y e a rs) c . c . C T R ( % ) E C G D ur a ti o n ( ye a rs ) C H F 1 F 8 0 D y sp n e a A F C R B B B L A D 3 7 + 2 F 4 7 E d e m a 6 5 A F I R B B B 1 6 3 F 8 7 E d e m a 7 0 A F L o w V o l t a g e 3 2 + 4 F 8 3 P alp itatio n 8 5 A F 4 0 D e a t h 4- 5 F 7 0 D y sp n e a 6 8 A F L V H 2 8 + 6 F 6 8 E d e m a 7 2 A F 3 8 + 7 F 7 4 D y sp n e a 7 8 A F I R B B B 3 4 8 M 5 2 D y sp n e a 6 8 A F l l C. C : chief complaint, CTR: cardiothoracic ratio, ECG: electrocardiogram, Duration (year): duration after diag- nosis of cardiomegaly or arrhythmia, Case 4 died of cerebral infarction. CHF: congestive heart failure, -: none, +.CHF (Class III or Class IV on the NYHAscale), F: female, M: male, AF: atrial fibrillation, CRBBB:complete right bundle branch block, IRBBB: incomplete right bundle branch block, LAD: left axis deviation, Low Volt- age: low voltage in limb lead, LVH:left ventricular hypertrophy with inversion of T wave and high voltage in left precordial lead. was the chief complaint of three patients. Chest radiographs effective in these cases. One patient died of cerebral infarction showed markedly enlarged cardiac silhouettes from the time at the age of 83. Nopatient died as the result of congestive of the patients' first visit to our hospital. The range of the most heart failure. recent cardiothoracic ratios was from 65%to 88%, with a mean of 143%. The electrocardiograms showed atrial fibrillation in Changes in the cardiothoracic ratio (Fig. 1) all patients, incomplete right bundle branch block in two pa- Changes in the cardiothoracic ratio in the compensated state tients, complete right bundle branch block and left axis devia- of congestive heart failure are shown in Fig. 1. The cardio- tion in one patient, and left ventricular hypertrophy in one pa- thoracic ratio increased gradually. The range of cardiothoracic tient. Three patients were treated with digitalis because of atrial ratios from the first visit to our hospital was from 57%to 80%, fibrillation with rapid ventricular response. The meanduration with a meanof 68.5%, and the range from the most recent visit after diagnosis of cardiomegaly or arrhythmia was 29.5 years was from 65%to 88%, with a mean of74.3%. (range, 1 1 to 40 years). Five patients were categorized as Class III or Class IV on the NewYorkHeartAssociation scale (NYHA Findings of two-dimensional and color Doppler echocardio- scale) during their clinical course. Although six patients were grams (Table 2) admitted to our hospital because of worsening edemaor con- In each case, the echocardiogram showeda markedbilat- gestive heart failure, treatment with diuretics or digitalis was eral atrial dilatation with almost normal wall motion of both CTR (%) 100_ -#- Case 1 -O- Case 2 90- ^^» -å²- Case3 -+^^å80- a----'* /V" ^^ ^ å -T- Case5 + 70_ V V ^-^^f -V-Case6 i__ * ^g^PP^ ---Case7 V--~~~J*^^^ 60- CT -G- Case8 50- 40- 30- '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 (Year) Figure 1. Changes in the cardiothoracic ratio. InternalMedicine Vol. 38, No. 2 (February 1999) 113 Arima et al Table 2. Findings of Two-Dimensional and Color Doppler Echocardiograms L V D d L V D s E F IV S L V P W L A D R A D T R M R P H Case No. (m m ) (m m ) (m m ) (m m ) (m m ) (m m ) 1 4 8 3 0 0 .7 6 1 2 1 3 6 9 8 0 + + + + + 2 4 0 2 6 0 .7 2 1 0 l l 7 0 7 6 + + 3 4 9 3 2 0 .7 2 1 0 1 0 6 5 6 8 + 4 4 2 3 0 0 .6 4 l l 1 0 7 0 6 9 + + + + 5 4 2 2 8 0 .7 0 1 2 1 2 5 5 5 8 + + + 6 3 9 2 7 0 .6 6 l l l l 6 0 6 0 + + 7 5 0 3 0 0 .7 8 1 0 1 0 6 1 6 4 + + 8 4 1 2 5 0 .7 7 1 0 1 0 6 5 6 0 + + LVDd: left ventricular diastolic dimension, LVDs: left ventricular systolic dimension, EF: ejection fraction, IVS: interventricular septal thickness, LVPW: left ventricular posterior wall thickness, LAD left atrial dimen- sion, RAD: right atrial dimension, TR: tricuspid regurgitation, MR: mitral regurgitation, PH: pulmonaly hyper- tension. ventricles. The left ventricular end diastolic dimension was gitation. Upon treatment with diuretics, the edema and con- 43.914.1 mm, and the ejection fraction was 0.72±0.05. Wall gestion disappeared, but the cardiomegaly improved only thickness of the left ventricle was within the normal limits in slightly. Follow-up chest radiographs are shown in Fig. 2. The all but one patient. The average dimension of the left atrium patient's cardiothoracic ratio increased gradually. Magnetic was 64.4±5.0 mm and that of the right atrium was 66.9±7.4 resonance imaging revealed a bilateral atrial dilatation in the mm.
Load more

Recommended publications
  • Cardiac Involvement in COVID-19 Patients: a Contemporary Review
    Review Cardiac Involvement in COVID-19 Patients: A Contemporary Review Domenico Maria Carretta 1, Aline Maria Silva 2, Donato D’Agostino 2, Skender Topi 3, Roberto Lovero 4, Ioannis Alexandros Charitos 5,*, Angelika Elzbieta Wegierska 6, Monica Montagnani 7,† and Luigi Santacroce 6,*,† 1 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Coronary Unit and Electrophysiology/Pacing Unit, Cardio-Thoracic Department, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] 2 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Cardiac Surgery, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] (A.M.S.); [email protected] (D.D.) 3 Department of Clinical Disciplines, School of Technical Medical Sciences, University of Elbasan “A. Xhuvani”, 3001 Elbasan, Albania; [email protected] 4 AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Clinical Pathology Unit, Policlinico University Hospital of Bari, 70124 Bari, Italy; [email protected] 5 Emergency/Urgent Department, National Poisoning Center, Riuniti University Hospital of Foggia, 71122 Foggia, Italy 6 Department of Interdisciplinary Medicine, Microbiology and Virology Unit, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70124 Bari, Italy; [email protected] 7 Department of Biomedical Sciences and Human Oncology—Section of Pharmacology, School of Medicine, University of Bari “Aldo Moro”, Policlinico University Hospital of Bari, p.zza G. Cesare 11, 70124 Bari, Italy; [email protected] * Correspondence: [email protected] (I.A.C.); [email protected] (L.S.) † These authors equally contributed as co-last authors. Citation: Carretta, D.M.; Silva, A.M.; D’Agostino, D.; Topi, S.; Lovero, R.; Charitos, I.A.; Wegierska, A.E.; Abstract: Background: The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) Montagnani, M.; Santacroce, L.
    [Show full text]
  • Evidence of Atrial Functional Mitral Regurgitation Due to Atrial Fibrillation Reversal with Arrhythmia Control
    Journal of the American College of Cardiology Vol. 58, No. 14, 2011 © 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.06.032 Heart Rhythm Disorders Evidence of Atrial Functional Mitral Regurgitation Due to Atrial Fibrillation Reversal With Arrhythmia Control Zachary M. Gertz, MD,* Amresh Raina, MD,* Laszlo Saghy, MD,† Erica S. Zado, PA-C,* David J. Callans, MD,* Francis E. Marchlinski, MD,* Martin G. Keane, MD,* Frank E. Silvestry, MD* Philadelphia, Pennsylvania; and Szeged, Hungary Objectives The purpose of this study was to determine whether atrial fibrillation (AF) might cause significant mitral regurgi- tation (MR), and to see whether this MR improves with restoration of sinus rhythm. Background MR can be classified by leaflet pathology (organic/primary and functional/secondary) and by leaflet motion (nor- mal, excessive, restrictive). The existence of secondary, normal leaflet motion MR remains controversial. Methods We performed a retrospective cohort study. Patients undergoing first AF ablation at our institution (n ϭ 828) were screened. Included patients had echocardiograms at the time of ablation and at 1-year clinical follow-up. The MR cohort (n ϭ 53) had at least moderate MR. A reference cohort (n ϭ 53) was randomly selected from those patients (n ϭ 660) with mild or less MR. Baseline echocardiographic and clinical characteristics were compared, and the effect of restoration of sinus rhythm was assessed by follow-up echocardiograms. Results MR patients were older than controls and more often had persistent AF (62% vs. 23%, p Ͻ 0.0001).
    [Show full text]
  • Mitral Valve Disease in Dogs- Truly Epic Kristin Jacob, DVM, DACVIM CVCA Cardiac Care for Pets Towson, MD
    Mitral Valve Disease in Dogs- Truly Epic Kristin Jacob, DVM, DACVIM CVCA Cardiac Care for Pets Towson, MD Chronic degenerative mitral valvular disease (DMVD) is the most common heart disease in dogs. In dogs with congestive heart failure, 75% have mitral regurgitation/degenerative valvular disease. Almost all have tricuspid regurgitations as well, but clinically the mitral regurgitation is the most significant. Degenerative valvular disease is most common in small breed dogs and more common in males than females. DMVD has been proven to be inherited in the Cavalier King Charles Spaniel and the Dachshund but several other breeds are predisposed, such as Bichons, poodles, Chihuahuas, Miniature Schnauzers, Boston Terriers. The cause of degenerative valvular disease remains unknown. However, the valve changes occur due to a destruction of collagen, deposition of mucopolysaccharide in the spongiosa and fibrosa layer of mitral valve, which also affects chordae tendinea. These changes prevent effective coaptation of the valve leaflets leading to progressive mitral regurgitation. Mitral regurgitation (MR) leads to decreasing forward output and increasing left atrial and left ventricular dilation and remodeling as well as activation of the neurohormonal systems. Typically, patients will have 2-3 years in asymptomatic phase (time between when heart murmur detected) until symptoms develop - congestive heart failure (CHF). We can detect progressive heart enlargement 6-12 months prior to the development of CHF. This means that we have a fairly long time period to intervene with therapy and alter the progression of the disease - we know what’s coming! Eventually left atrial pressure increases sufficiently and pulmonary congestion develops leading to symptoms of CHF and can also lead to pulmonary hypertension.
    [Show full text]
  • Giant Right Atrium Or Ebstein Anomaly? Hacer Kamalı1, Abdullah Erdem1*, Cengiz Erol2 and Atıf Akçevin3
    ISSN: 2378-2951 Kamalı et al. Int J Clin Cardiol 2017, 4:104 DOI: 10.23937/2378-2951/1410104 Volume 4 | Issue 4 International Journal of Open Access Clinical Cardiology CASE REPORT Giant Right Atrium or Ebstein Anomaly? Hacer Kamalı1, Abdullah Erdem1*, Cengiz Erol2 and Atıf Akçevin3 1Department of Pediatric Cardiology, Istanbul Medipol University, Turkey 2Department of Radiology, Istanbul Medipol University, Turkey 3Department of Cardiovascular Surgery, Istanbul Medipol University, Turkey *Corresponding author: Abdullah Erdem, Associate Professor of Pediatric Cardiology, Department of Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey, Tel: +905-0577-05805, Fax: +90212467064, E-mail: drabdullaherdem@ hotmail.com partment for exercise intolerance. She had been diag- Abstract nosed and followed up as Ebstein anomaly for ten years. Many acquired and congenital pathologies could cause en- Her heart rate was 75/min with normal jugular venous largement of Right Atrium (RA). In rare pathologies we couldn’t find an obvious reason for enlargement of RA. Sometimes it pressure. Findings of lung examination were normal. leads to misdiagnosis if we try to explain an unknown pa- Auscultation of heart revealed a 2/6 systolic murmur on thology with well known pathology. In this article we de- the lower left edge of the sternum. On abdominal ex- scribe a woman who presented with giant enlargement of amination, there was no organomegaly. Arterial Oxygen the RA misdiagnosed as Ebstein anomaly. Cardiac MRI is highly helpful for differential diagnosis of these kinds of atrial Saturation (SpO2) was 98%. Electrocardiography (ECG) pathologies. Although it is rare, giant RA should be consid- revealed absence of atrial fibrillation, the rhythm was ered in differential diagnosis of huge RA without an obvious sinus but there was right axis deviation and right bundle cause.
    [Show full text]
  • Young Adults. Look for ST Elevation, Tall QRS Voltage, "Fishhook" Deformity at the J Point, and Prominent T Waves
    EKG Abnormalities I. Early repolarization abnormality: A. A normal variant. Early repolarization is most often seen in healthy young adults. Look for ST elevation, tall QRS voltage, "fishhook" deformity at the J point, and prominent T waves. ST segment elevation is maximal in leads with tallest R waves. Note high take off of the ST segment in leads V4-6; the ST elevation in V2-3 is generally seen in most normal ECG's; the ST elevation in V2- 6 is concave upwards, another characteristic of this normal variant. Characteristics’ of early repolarization • notching or slurring of the terminal portion of the QRS wave • symmetric concordant T waves of large amplitude • relative temporal stability • most commonly presents in the precordial leads but often associated with it is less pronounced ST segment elevation in the limb leads To differentiate from anterior MI • the initial part of the ST segment is usually flat or convex upward in AMI • reciprocal ST depression may be present in AMI but not in early repolarization • ST segments in early repolarization are usually <2 mm (but have been reported up to 4 mm) To differentiate from pericarditis • the ST changes are more widespread in pericarditis • the T wave is normal in pericarditis • the ratio of the degree of ST elevation (measured using the PR segment as the baseline) to the height of the T wave is greater than 0.25 in V6 in pericarditis. 1 II. Acute Pericarditis: Stage 1 Pericarditis Changes A. Timing 1. Onset: Day 2-3 2. Duration: Up to 2 weeks B. Findings 1.
    [Show full text]
  • Atrial Infarction
    Cardiovascular and Metabolic Science Review Vol. 31 No. 1 January-March 2020 Atrial infarction: a literature review Infarto atrial: revisión de la literatura Laura Duque-González,* María José Orrego-Garay,‡ Laura Lopera-Mejía,§ Mauricio Duque-Ramírez|| Keywords: Infarction, atrium, ABSTRACT RESUMEN atrial fibrillation, embolism and Atrial infarction is an often-missed entity that has been El infarto atrial es una entidad frecuentemente olvidada, thrombosis. described in association with ventricular infarction ha sido descrita en asociación con el infarto ventricular or as an isolated disease, which is mainly caused by o de manera aislada y es causado principalmente Palabras clave: atherosclerosis. The electrocardiographic diagnostic por aterosclerosis. Los criterios diagnósticos Infarto, aurícula, criteria were proposed more than fifty years ago and electrocardiográficos fueron propuestos hace más de 50 fibrilación auricular, have not yet been validated. The diagnosis is based on años y aún no han sido validados. El diagnóstico se basa en embolia y trombosis. elevations and depressions of the PTa segment and changes el hallazgo de elevación o depresión del segmento PTa y de in the P wave morphology. However, supraventricular alteraciones en la morfología de la onda P; sin embargo, arrhythmias such as atrial fibrillation are the most common las arritmias supraventriculares como la fibrilación atrial finding and often predominate in the clinical presentation. son las más comunes y con frecuencia predominan en el Early recognition and treatment may prevent serious cuadro clínico. Un rápido reconocimiento y tratamiento complications such as mural thrombosis or atrial rupture. pueden ayudar a prevenir complicaciones graves como la Further studies need to be carried out in order to establish trombosis mural o la ruptura auricular.
    [Show full text]
  • Spontaneous Hemopericardium Leading to Cardiac Tamponade in a Patient with Essential Thrombocythemia
    SAGE-Hindawi Access to Research Cardiology Research and Practice Volume 2011, Article ID 247814, 3 pages doi:10.4061/2011/247814 Case Report Spontaneous Hemopericardium Leading to Cardiac Tamponade in a Patient with Essential Thrombocythemia Anand Deshmukh,1, 2 Shanmuga P. Subbiah,3 Sakshi Malhotra,4 Pooja Deshmukh,4 Suman Pasupuleti,1 and Syed Mohiuddin1, 4 1 Department of Cardiovascular Medicine, Creighton University Medical Center, Omaha, NE 68131, USA 2 Creighton Cardiac Center, 3006 Webster Street, Omaha, NE 68131, USA 3 Department of Hematology and Oncology, Creighton University Medical Center, Omaha, NE 68131, USA 4 Department of Internal Medicine, Creighton University Medical Center, Omaha, NE 68131, USA Correspondence should be addressed to Anand Deshmukh, [email protected] Received 30 October 2010; Accepted 29 December 2010 Academic Editor: Syed Wamique Yusuf Copyright © 2011 Anand Deshmukh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acute cardiac tamponade requires urgent diagnosis and treatment. Spontaneous hemopericardium leading to cardiac tamponade as an initial manifestation of essential thrombocythemia (ET) has never been reported in the literature. We report a case of a 72-year-old Caucasian female who presented with spontaneous hemopericardium and tamponade requiring emergent pericardiocentesis. The patient was subsequently diagnosed to have ET. ET is characterized by elevated platelet counts that can lead to thrombosis but paradoxically it can also lead to a bleeding diathesis. Physicians should be aware of this complication so that timely life-saving measures can be taken if this complication arises.
    [Show full text]
  • Accuracy of Electrocardiographic Criteria for Atrial Enlargement: Validation with Cardiovascular Magnetic Resonance
    Accuracy of Electrocardiographic Criteria for Atrial Enlargement: Validation with Cardiovascular Magnetic Resonance The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Tsao, Connie W., Mark E. Josephson, Thomas H. Hauser, T. David O'Halloran, Anupam Agarwal, Warren J. Manning, and Susan B. Yeon. 2008. Accuracy of electrocardiographic criteria for atrial enlargement: Validation with cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance 10(1): 7. Published Version doi://10.1186/1532-429X-10-7 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:10140325 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Journal of Cardiovascular Magnetic Resonance BioMed Central Research Open Access Accuracy of electrocardiographic criteria for atrial enlargement: validation with cardiovascular magnetic resonance Connie W Tsao1, Mark E Josephson1, Thomas H Hauser1, T David O'Halloran1, Anupam Agarwal1,2, Warren J Manning1,3 and Susan B Yeon*1 Address: 1Harvard-Thorndike Laboratory and the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, USA, 2Cardiovascular and Metabolic Division, GlaxoSmithKline Pharmaceuticals, 1250 Collegeville
    [Show full text]
  • Pathophysiology of Atrial Fibrillation. Systemic Review
    PRACA POGLĄDOWA/RevieW papeR Folia Cardiologica 2020 tom 15, nr 5, strony 349–354 DOI: 10.5603/FC.2020.0050 Copyright © 2020 Via Medica ISSN 2353–7752 Pathophysiology of atrial fibrillation. Systemic review Patofizjologia migotania przedsionków. Przegląd systemowy Andrzej Wysokiński, Sebastian Sawonik●iD , Katarzyna Wysokińska Department of Cardiology, Medical University of Lublin, Lublin, Poland Abstract Atrial fibrillation (AF) is an arrhythmia in which chaotic electrical signals are generated in the atria. AF can be classified as first episode AF, paroxysmal AF, persistent AF, long-standing persistent AF and permanent AF. Hence, AF is one of the biggest problems of contemporary health care (due to severe complications like thromboembolic disease and huge expenses associated with the treatment). The pathophysiology of the AF includes a triggered activity in the myocardium and also left atrial enlargement (LAE), and remodelling of the atria that may result in an interatrial block (IAB). IAB is prolonged conduction between the atria and is diagnosed in electrocardiography (ECG) when P-wave duration ≥ 110 ms. Other ECG changes coexisting with IAB, LAE and also remodelling of the atria are attributed to P-wave dispersion ≥ 40 ms, and a P-wave terminal force in V1 ≤ –0.04 mm/s. Remodelling of the atria leads to structural, cellular and hormonal changes. At the cellular scale — mitochondrial size and count are enlarged. A neurohormonal imbalance is also related to arrhythmia. An increased level of atrial natriuretic peptide, B-type natriuretic peptide, angiotensin II, transforming growth factor-β1 are observed in the case of cellular and ion channels changes. Atrial fibrillation is a significant problem posed to modern health care.
    [Show full text]
  • Case Report Chagas Cardiomyopathy Presenting As Symptomatic Bradycardia: an Underappreciated Emerging Public Health Problem in the United States
    Hindawi Case Reports in Cardiology Volume 2017, Article ID 5728742, 5 pages https://doi.org/10.1155/2017/5728742 Case Report Chagas Cardiomyopathy Presenting as Symptomatic Bradycardia: An Underappreciated Emerging Public Health Problem in the United States Richard Jesse Durrance,1 Tofura Ullah,1 Zulekha Atif,1 William Frumkin,2 and Kaushik Doshi1 1 Department of Internal Medicine, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA 2Department of Cardiology, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY 11418, USA Correspondence should be addressed to Richard Jesse Durrance; [email protected] Received 13 February 2017; Accepted 18 July 2017; Published 16 August 2017 Academic Editor: Aiden Abidov Copyright © 2017 Richard Jesse Durrance et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Chagas cardiomyopathy (CCM) is traditionally considered a disease restricted to areas of endemicity. However, an estimated 300,000 people living in the United States today have CCM, of which its majority is undiagnosed. Wepresent a case of CCM acquired in an endemic area and detected in its early stage. A 42-year-old El Salvadoran woman presented with recurrent chest pain and syncopal episodes. Significant family history includes a sister inEl Salvador who also began suffering similar episodes. Physical exam and ancillary studies were only remarkable for sinus bradycardia. The patient was diagnosed with symptomatic sinus bradycardia and a pacemaker was placed. During her hospital course, Chagas serology was ordered given the epidemiological context from which she came.
    [Show full text]
  • Surgical Treatment of Idiopathic Enlargement of the Right Atrium
    Hindawi Case Reports in Surgery Volume 2018, Article ID 7241309, 5 pages https://doi.org/10.1155/2018/7241309 Case Report Surgical Treatment of Idiopathic Enlargement of the Right Atrium Francesca Chiara Surace, Federica Iezzi , Massimo Colaneri, and Marco Pozzi Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria, Ospedali Riuniti Ancona “Umberto I-G. M. Lancisi-G. Salesi”, Ancona, Italy Correspondence should be addressed to Federica Iezzi; [email protected] Received 25 June 2018; Accepted 26 August 2018; Published 20 September 2018 Academic Editor: Shuli Silberman Copyright © 2018 Francesca Chiara Surace et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Idiopathic enlargement of the right atrium (IERA) is a very rare abnormality. Approximately one-half (48%) of the patients with a congenital enlargement of the right atrium have no symptoms. When they occur, symptoms include shortness of breath (28% of cases), palpitations (17%), arrhythmias (12%), and in rare cases, right heart failure and extreme tiredness. We report one such case of a young man with a disproportionally enlarged right atrium. The basal transthoracic echocardiogram demonstrated a huge right atrium with a thick smoke pattern and mild tricuspid regurgitation in the absence of congenital heart disease. Magnetic resonance imaging confirmed the right atriomegaly, with initial compression of the right ventricle, and excluded congenital heart defects or absence of pericardium. The patient underwent surgical resection of the right atrial wall and the atriotomy was closed, leaving an atrial chamber of normal consistency and size.
    [Show full text]
  • Normal P Wave, in Atrial Enlargements, Artifacts, Dextrocardia and Interatrial Blocks
    Class 6 – SOLAECE Course Normal P wave, in atrial enlargements, artifacts, dextrocardia and interatrial blocks Authors: Antonio Bayés de Luna, Andrés R. Pérez-Riera, Adrian Baranchuk, Diego Conde The authors do not report any conflict of interest regarding this presentation 1. Introduction For some authors the name “atrial abnormalities” encompass the concept of atrial enlargement and atrial blocks (Bayés de Luna 2013)( Lee 2007). In this work we will expose the ECG/VCG characteristics of both concepts, emphasizing, as it happens with ventricular hypertrophy and ventricular blocks, that often the ECG/ VCG pattern of atrial enlargement especially of left atrial enlargement (LAE) is explained by the coexistence of interatrial block (IAB). However as we will see later there are clear evidences that the pattern of IAB may exist without the association of atrial enlargement/hypertrophy. Therefore atrial blocks and atrial enlargement are separate entities that are often associated with each other. Therefore we do not consider it appropriate to use the “umbrella” term atrial abnormalities to include both concepts without distinguishing between them (Lee 2007), as some authors do (Bayés de Luna 2013: ) (Tsao 2008). Depolarization and repolarization mode of the atria and ventricles A) Atrial muscle strip Depolarization P Longitudinal Repolarization Ta P Ta B) Ventricular myocardium R Depolarization T Transversal Repolarization q s Atrial Activation Pathways A Hypothesis currently accepted B Previous hypotesis SVC SVC SPV SPV IPV A LA LA IPV SAN SAN M BB RA RA P LV LV AV node AV node RV RV IVC IVC A: Anterior internodal bundle SVC: Superior Vena Cava M: Middle internodal or Wenckebach bundle IVC: Inferior Vena Cava P: Posterior internodal or Thorel Bundle RA: Right Atrium BB: Bachmann’s Bundle LA: Left Atrium SAN: Sinoatrial Node Old or previous hypothesis B – The activation wave spreads in a radiated way through the atria, just as the waves in a lake when you throw a stone in it.
    [Show full text]